Job Description

Roles and Responsibilities: . 2-3 years of experience in processing claims adjudication and adjustment process . Experience in professional (HCFA) and institutional (UB) claims . Knowledge in handling authorization, COB, duplicate and pricing process . Knowledge of healthcare insurance policy concepts including in network, out of network providers, deductible, coinsurance, co-pay, out of pocket, maximum inside limits and exclusions, state variations . Audit claims as outlined by Policies and Procedures. Utilize appropriate system-generated reports applicable for specialty claims. . Document, track findings per organizational guidelines for reporting purpose. . Based upon trends, determine ongoing Claims Examiner training needs and develop/implement training programs as approved by Senior Management. . Conduct in-depth research of contract issues, system-related problems, claims processing Policies and Procedures, etc., to confirm cause of trends. Recommend actions/resolutions to Senior Management. . Work with other organizational departments to develop corrective action plans to improve accuracy of the claims adjudication processes and assure compliance with organizational requirements and applicable regulations. . Assist in the development of Claims Department Policies and Procedures. . Attend organizational meetings as required . Adhere to organizational Policies and Procedures. Requirements: . 2-3 years of experience in processing claims adjudication and adjustment process . Experience in professional (HCFA), institutional (UB) claims (optional) . Both under graduates and post graduates can apply . Good communication (Demonstrate strong reading comprehension and writing skills) . Able to work independently, strong analytic skills Work Timings: Required schedule availability for this position is Monday-Friday 5.30PM/3.30AM IST (AR SHIFT). The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend\'s basis business requirement

foundit